Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit)
This week’s EM Board Survival Guide covers the must-knows for the inservice exam concerning ENT. This post also features stellar artwork from Dr. Katy Hanson at Hanson’s Anatomy:
Boards Must-Knows:
1) Cavernous sinus thrombosis: Often confused with cerebral venous sinus thrombosis. Midface infection (sinusitis) + eye swelling/proptosis/CN palsy. Diagnose with CT w/ contrast, MRV if available. Treatment: Antibiotics, ENT consult.
2) Alveolar osteitis (dry socket): Tooth plucked, then severe pain 2-3 days later secondary to osteomyelitis. Treatment: dental block, antibiotics, urgent dental follow up.
3) Oral lesions: Anterior (hand-foot-mouth, herpetic gingivostomatitis) vs posterior (herpangina). Be able to identify on pictures and treat accordingly.
4) Acute necrotizing ulcerative gingivostomatitis (trench mouth): Identify picture or clinical description. Rx: chlorhexidine rinse, antibiotics, dental follow up.
5) Ear foreign bodies: Button battery => emergent removal. Bug => drown with viscous lidocaine; remove.
6) Mastoiditis: Otitis media complication. Know classic exam findings. Treatment: antibiotics (cover OM bugs); ENT.
7) Meniere’s disease: Hearing issues + peripheral vertigo + aural fullness, waxes and wanes.
8) Epistaxis: anterior = Kiesselbach’s plexus; posterior = sphenopalatine artery. Have a systematic approach: https://emupdates.com/management-of-epistaxis/
9) Epiglottitis: H. influenzae historically, now Staph/Strep; also, originally disease in kids, now adults. Know classic x-ray. Treatment: vanc/ceftriaxone; intubate in OR ideally.
10) Ludwig’s angina: Know classic presentation and examination findings (elevated tongue, firm floor of mouth). Treatment: antibiotics (polymicrobial); airway management (prepare multiple options; ideally awake fiberoptic).
From Dr. Katy Hanson at Hanson’s Anatomy:
